Disorder Overview

According to recent polls conducted by the National Sleep Foundation, nearly 7 out of 10 Americans say they experience frequent sleep problems. However, when proper diagnosis and treatment of sleep disorders occurs, the feeling of sleepiness declines, memory improves and safety risks decrease dramatically. In fact, sleep disorder specialists help an estimated 85 to 90% of their patients get better sleep. With the wealth of treatment options now available, a good night’s sleep is within reach.

Compounding the problem is the fact that most people know when to seek medical help for physical discomfort such as fever or pain – but sleep problems are often overlooked or ignored. In fact, the overwhelming majority of people with sleep disorders are undiagnosed and untreated.

THE MOST COMMON SLEEP DISORDERS ARE DISCUSSED BELOW:

INSOMNIA

According to the Mayo Clinic, most people with insomnia have difficulty falling asleep; difficulty staying asleep; waking up unrefreshed or tired, and wanting to sleep longer; or have daytime sleepiness or urges to sleep during the day. This is common for the majorty of patients with sleep disorders.

Symptoms

Insomnia most often stems from some other problem, such as a medical condition that causes pain or use of substances that interfere with sleep. Common causes of insomnia include:

Stress. Concerns about work, school, health or family can keep your mind active at night, making it difficult to sleep. Stressful life events, such as the death or illness of a loved one, divorce, or a job loss, may lead to insomnia.

Anxiety. Everyday anxieties as well as more-serious anxiety disorders may disrupt your sleep.

Depression. You might either sleep too much or have trouble sleeping if you’re depressed. This may be due to chemical imbalances in your brain or because worries that accompany depression may keep you from relaxing enough to fall asleep. Insomnia often accompanies other mental health disorders as well.

Medications. Prescription drugs that can interfere with sleep include some antidepressants, heart and blood pressure medications, allergy medications, stimulants (suck as Ritalin) and corticosteroids. Many over-the-counter medications, including some pain medication combinations, decongestants and weight-loss products, contain caffeine and other stimulants. Antihistamines may initially make you groggy, but they can worsen urinary problems, causing you to get up more during the night.

Caffeine, nicotine and alcohol. Coffee, tea, cola and other caffeine-containing drinks are well-known stimulants. Drinking coffee in the late afternoon can keep you from falling asleep at night. Nicotine in tobacco products is nother stimulant that can cause insomnia. Alcohol is a sedative that may help you fall asleep, but it prevents deeper stages of sleep and often causes you to awaken in the middle of the night.

Medical conditions. If you have chronic pain, breathing difficulties or need to urinate frequently, you might develop insomnia. Conditions linked with insomnia include arthritis, cancer, congestive heart failure, diabetes, lung disease, gastresophageal reflux desease (GERD, overactive thyroid, stroke, Parkinson disease and Alzheimer’s disease. Making sure that your medical conditions are well treated may help with your insomnia. If you have arthritis, for example, taking a pain reliever before bed may help you sleep better.

Change in your environment or work schedule. Travel or working a late or early shift can disrupt your body’s circadian rhythms, making it difficult to sleep. Your circadian rhythms act as internal clocks, guiding such things as your wak-sleep cycle, metabolism and body temperature.

Prro sleep habits. Habits that help promote good sleep are called “sleep hygiene.” Poor sleep hygiene includes an irregular sleep schedule, stimulating activities before bed, an uncomfortable sleep environment and use of your bed for activities other than sleep or sex.

“Learned” insomnia. This may occur when you worry excessively about not being able to sleep well and try too hard to fall asleep. Most people with this condition sleep better when they’re away from their usual sleep environment or when they don’t try to sleep, such as when they’re watching TV or Reading.

Eating too much late in the evening. Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down, making it difficult to go to sleep. Many people also experience heartburn, a backlfow of acid and food from the stomach to the esophagus after eating. This uncomfortable feeling may keep you awake.

Insomnia and Aging

Insomnia becomes more prevalent with age. As you get older, changes can occur that may affect your sleep. You may experience:

A Change in sleep patterns. Sleep often becomes less restful as you age. You spend more time in stages 1 and 2 of non-rapid eye movement (NREM) sleep and less time in stages 3 and 4. Stage 1 is transitional sleep, stage 2 is light sleep, and stage 3 is deep (delta) sleep, the most restful kind. Because you’re sleeping more lightly, you’re also more likely to awaken. With age, your internal clock often advances, which means you get tired earlier in the evening and wake up earlier in the morning. But older people still need the same amount of sleep as younger people do.

Change in activity. You may be less physically or socially active. Activity helps promote a good night’s sleep. You may also be more likely to take a daily nap, which also can interfere with sleep at night.

A change in health. The chronic pain of conditions such as arthritis or back problems as well as depression, anxiety and stress can interfere with sleep. Older men often develop noncancerous enlargement of the prostate gland (benign prostratic hyperplasia). which can cause the need to urinate frequently, interrupting sleep. In women, hot flahes that accompany menopause can be equallly disruptive.

Increase use of medications. Older people use more prescription drugs than younger people do, which increases the chance of insomnia caused by a medication.

Sleep Problems may be a concern for children and teenagers as well. Some children and teenagers simply have trouble getting to sleep or resist a regular bedtime because their internal clocks are more delayed. They want to go to bed later and sleep later in the morning.

Risk Factors

Nearly everyone has an occasional sleepless night. But your risk of insomnia is greater if:

You’re over age 60. Because of changes in sleep patterns, insomnia increases with age. According to some estimtes, insomnia affects nearly half of all older people.

You have a mental health disorder. Many disorders, including depression, anxiety, bipolar disorder and post-traumatic stress disorder, disrupt sleep. Early-morning awakening is a classic symptom of depression.

You’re under a lot of stress. Stressful events can cause temporary insomnia, and major or long-lasting stress, such as the death of a loved one or a divorce, can lead to chronic insomnia. Being poor or unemployed also increases the risk.

You work night or changing shifts. Working at night or frequently changing shifts increases your risk of insomnia.

You travel long distances. Jet lag from traveling across multiple time zones can cause insomnia.

SLEEP APNEA

Sleep apnea is an illness in which the person stops breathing many times during sleep for longer than 10 seconds at a time. They snore an awaken unrefreshed in the mornings and complain of excessive daytime sleepiness. Untreated sleep apnea results in the following:

Daytime fatigue and sleepiness

Morning headaches and dry mouth

Loss of memory and concentration

Irritablity and depression

High blood pressure

Cardiovascular risks such as stroke and heart attacks

In obstructive sleep apnea, the muscles of the tongue, throat, and larynx lose their elasticity (muscle tone) and collapse during sleep, thus resulting in a blockage of airflow into the lungs. This may be predisposed by an enlarged palate, receded jaw bone, or a genetically narrowed airway behind the tongue. Obesity and aging worsen the problem a reduction of body oxygen level occurs and the brain reflexively increases heart rate, blood pressure and finally awakens you so that breathing my be resumed. Rarely, other cases of sleep apnea occur where the sleeping brain does not send nerve impulses to the diaphragm muscles which are responsible for breathing.

How do I know if I have sleep apnea?

Loud snoring is a common sympton of sleep apnea and often precedes the development of the other symptoms such as choking and gasping during sleep. Sleep becomes very restless and light, and the person frequently moves around in an abnorman manner. Excessive perspiration, palpitations and feeling of impending doom (panic) may occur. Frequent urination is a common symptom, and in children, unusual bed-wetting is suggestive of the development of sleep apnea syndrome. They may become disoriented after awakening and have attention and behavioural difficulties at shcool and in social circumstances.

High blood pressure or any of the other conditions mentioned above may become increasingly difficult to manage.

How is the diagnosis made?

A definitive diagnosis can only be provided by a specialized test known as Polysomnography which is conducted in a sleep laboratory. This may be preceded by a careful detailed consultation visit with a sleep specialist. An appointment is booked for you overnight stay in the sleep laboratory for conducting the sleep study. In a follow-up appointment, approximately one month later, your sleep specialist will discuss the results of your test and thoroughly asses your concerns.

How does one treat sleep apnea?

The treatment plan always emphasises lifestyle changes. Many sufferes are overweight and stragtegies for weight reduction are advised. The use of medications is always discouraged unless it is absolutely essential in the treatment. Sleeping pills, tranquillizers, alcohol or any sim

RESTLESS LEGS SYNDROME

This is a disorder of the nervous system, which results in an uncomfortable sensation such as pain, pressure, burning or prickly sensations, which may occur in the legs and arms making it difficult to fall asleep or to remain asleep. The symptoms are relieved by messaging or moving the legs or feet. In many cases, this is accompanied with leg movements that occur while the person is alseep and results in frequent awakening.

The net effect is an unrestorative sleep causing daytime fatigue and sleepiness, irritablity and depressed modds and distrubances of memory and concentration. Again, an overnight sleep study will determine the presence and severity of the condition and its treatment. The disorder is often triggered by low back problems; nerve disorders and the use of some antidespressant medication.

PARASOMNIA

(Sleepwalking, Sleep talking, confusional arousals and violence in sleep) There are many different types of disorders in sleep which result in semiconcious awakenings and behaviors. These may be disruptibe and dangerous to the person or the people around them. These behaviors may occur in normal sleep (non-REM sleep Parasomnia) and in dream sleep (REM sleep Parasomnia) and can often mimic seizures and bizarre behaviors. An overnight sleep study is essential in determining the type and treatment of this condition.

Treatment includes making family and friends aware of such behaviors and making the environment safer, i.e. removal of sharp objects, installing barriers to the stairs, etc. Avoiding sleep deprivation (staying up late) and use of alcohol reduces the risk of events. In some cases where the potential for injury exist, medications may be necessary.

NARCOLEPSY

This often inherited disorder of the central nervous system occurs as a result of a deficiency of specialized nerve cells (Orexin-Hypocretin cells) controlling wakefullness. Thses results in severe daytime sleepiness sleep attacks and paralysis during the day, which my be triggered by emotional changes such as laughing, crying or tearful situations. It may be associated with dreams, nightmares or hallucinations. The condition usually begins in adolescence resulting in disruptions at school and at home and carries a higher risk of accidents on the road and in other situations. An overnight sleep study and a daytime sleepiness test (multiple sleep latency tests) are essential in its diagnosis after a very careful history and consultaiton visit. Treatment involves significant lifestyle changes, safety precautions, and often medication to improve symptoms.

SHIFT WORKERS

25% of the work force is presently engaged in shift work. Shift workers have very poor sleep, as their sleep does not coincide with natural biological time cues. This results in a very fragmented and reduced sleep, and eventual chronic sleep deprivaton. Shift workers also have ahigh incident of other diseases such as high blood pressure, ischemic heart disease, gastroesphageal reflux diseas, depression and obstructive sleep apnea. Workers with some of thses disorders, or any sleep disorder are not suited for shift work from a heal perspective.

OTHER SLEEP DISORDERS

There are approximately 100 sleep disorders presently known, and the consequences of the disorders are slowly becoming known to medical communities. More than 95% of people with sleep disorders go undiagnosed or untreated.